Provider Demographics
NPI:1720302748
Name:MARTERER, PATRICIA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JEAN
Last Name:MARTERER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 VINSON HWY SE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4881
Mailing Address - Country:US
Mailing Address - Phone:478-445-8015
Mailing Address - Fax:
Practice Address - Street 1:2450 VINSON HWY SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4881
Practice Address - Country:US
Practice Address - Phone:478-445-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical